Cardiac CT Angiography Manual

305 Pages·2015·10.861 MB·English

by  Robert Pelberg

Cardiac CT Angiography
Manual

Robert Pelberg
Cardiac CT
Angiography Manual
Second Edition
Robert Pelberg
The Christ Hospital Physicians
Ohio Heart and Vascular Center
The Lindner Center for
Research and Education
The Christ Hospital
Cincinnati , OH
USA
ISBN 978-1-4471-6689-4 ISBN 978-1-4471-6690-0 (eBook)
DOI 10.1007/978-1-4471-6690-0
Library of Congress Control Number: 2015941102
Springer London Heidelberg New York Dordrecht
© Springer-Verlag London 2015
This work is subject to copyright. All rights are reserved by the Publisher,
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The use of general descriptive names, registered names, trademarks, service
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The publisher, the authors and the editors are safe to assume that the advice and
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lication. Neither the publisher nor the authors or the editors give a warranty,
express or implied, with respect to the material contained herein or for any errors
or omissions that may have been made.
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In loving memory of my late father, Joe Pelberg,
who inspired me to be all that I could be.
To my wife, Wendy, and my amazing children, Josh,
Adam, and Noah, who make life worth living.

Pref ace
Since the publication of the first edition of this work, cardiac
CT angiography (CCTA) has come a long way. It is now a
mainstream, well-established cardiac diagnostic imaging
modality with widespread acceptance and application. This
second edition is meant to adhere to the guiding principles of
the first edition while serving as a useful and up-to-date
manual on the theory, performance, and application of
CCTA. In particular, this work will serve you well as a useful
summary of the field and an aid in the training process. It is
intended to make hard-to-understand concepts easy and
enjoyable by translating difficult ideas into simple terminol-
ogy and phraseology. It is meant to guide you through your
training process and to serve as a useful reference for those
already practicing CCTA. I feel this book should accompany
any CCTA laboratory. While this work maintains its form by
including a complete review of concepts in general CT and in
CCTA in particular (including cardiac anatomy, imaging arti-
facts, and more), it also includes many useful updates, which
include a more modern discussion of the technology, an
updated review of radiation and radiation dosing, a review of
the current appropriateness criteria and performance, inter-
pretation and reporting guidelines in the field, an update on
the most current performance, accuracy, and prognostic data,
as well as a review of the most modern, specific CCTA clini-
cal applications, including CCTA in the emergency depart-
ment, transcatheter aortic valve replacement, and functional
assessment of coronary stenoses including stress CCTA and
vii
viii Preface
CT FFR. I certainly hope you enjoy this book for years to
come as much as I have enjoyed writing it.
CCTA is constantly evolving and improving. New research
and clinical experience continue to rapidly evolve the tech-
nique. I believe the information in this book to be reliable
and in accord with the standards accepted at the time that the
document was written. However, in view of the possibility of
human error or changes in the field, I do not warrant that the
information contained herein is in every respect accurate or
complete, and I am not responsible for any errors or omis-
sions or for the results obtained from the use of such
information.
Readers are encouraged to confirm the information herein
with other sources. For example, and in particular, readers are
advised to check the product information sheet included in
the package insert of each drug and contrast agent they plan
to administer to be certain that information contained in this
document is accurate and that changes have not been made
in the recommended dose or in the contraindications for
administration. In addition, readers are encouraged to be
familiar with the concepts of radiation safety.
Cincinnati, OH, USA Robert Pelberg
Contents
1 Concepts in Radiation and Radiation Safety . . . . . 1
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
2 Basic Principles in Computed
Tomography (CT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Basic CT Physics and Technology . . . . . . . . . . . . . . 19
The CT Scanner. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
X Ray Detectors and X Ray Beam
Detection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Multislice CT (MSCT) . . . . . . . . . . . . . . . . . . . . . . . . 26
Image Reconstruction Techniques . . . . . . . . . . . . . . 30
Important CT Concepts and Terms. . . . . . . . . . . . . . 36
Convolution Filters. . . . . . . . . . . . . . . . . . . . . . . . . 36
CT Image Contrast. . . . . . . . . . . . . . . . . . . . . . . . . 36
Spatial Resolution. . . . . . . . . . . . . . . . . . . . . . . . . . 38
Temporal Resolution . . . . . . . . . . . . . . . . . . . . . . . 42
Contrast Resolution. . . . . . . . . . . . . . . . . . . . . . . . 44
Collimation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Image Noise. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Field of View. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Computer Screen Matrix. . . . . . . . . . . . . . . . . . . . 49
Hounsfield Units. . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Windowing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Image Axes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Pitch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
ix